If you know your child is coming to the next Refuel on Saturday March 17th 2012 save time at registration by pre-registering them on-line!
Please also fill in, and sign the Consents Form and bring it to the next event.
Download Consents Form here
PLEASE NOTE: We need the Consents Form filled in by the child's legal parent or guardian, if your child is being brought to Refuel by someone else, you MUST fill in and sign the consents form beforehand and send it with them.

Child's Details
Child's Legal Surname: Legal Forename:
Child's chosen name: (what they like to be called)
Date of Birth (including year): 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 199619971998199920002001200220032004200520062007200820092010
Child's E-mail Address: (to keep them informed about Refuel)
Child's Address:
Line 1:
Line 2:
Line 3:
Town/City:
County:
Postcode:
Name of church child attends: 
Our sessions will include active group games and quieter group and individual activities. The children will also be given refreshments. Please give details of any disability, medical or social needs your child has. (Please do not leave this section blank - write 'N/A' if there is no other information we need to know.)

Parent/Legal Guardian Details
This section should contain details of a person legally responsible for the child. If you are not this person, please fill this section in to the best of your knowledge.

Parent/Guardian's Surname: Forename: 
Relationship to child:
Parent/Guardian's Address: (Tick if this is the same as the child's address)
Line 1:
Line 2:
Line 3:
Town/City:
County:
Postcode:
Parent/Guardian's Home Telephone Number:
Parent/Guardian's Mobile Telephone Number(s):
Parent/Guardian's E-mail Address: (to keep them informed about Refuel or clarify any information entered here)

Person collecting the child from Refuel:
Please tick if same as above or fill in their details below.
Surname: Forename:
Relationship to child:
Contact number:

Please note: The information given on this form will be held for the duration of your child's time attending Refuel events and a short time afterwards. If you need to change any of this information, it is your responsibility to let us know.

Please tick if this is the child's first time at Refuel